Internal Medicine
Online ISSN : 1349-7235
Print ISSN : 0918-2918
ISSN-L : 0918-2918
62 巻, 12 号
選択された号の論文の32件中1~32を表示しています
EDITORIAL
ORIGINAL ARTICLES
  • Mitsuhiro Watanabe, Takeshi Kashimura, Mitsuo Ishizuka, Mayumi Kase, R ...
    2023 年 62 巻 12 号 p. 1707-1713
    発行日: 2023/06/15
    公開日: 2023/06/15
    [早期公開] 公開日: 2022/11/09
    ジャーナル オープンアクセス

    Objective Spontaneous mechanical alternans (MA), or pulsus alternans, has been observed in heart failure patients with hypertension or tachycardia for 150 years and is considered a sign of a poor prognosis. However, in some dilated cardiomyopathy (DCM) patients with MA, optimal medical therapy (OMT) brings left ventricular reverse remodeling (LVRR), a preferable prognostic indicator. This study examined the probability of LVRR in DCM patients with spontaneous MA and whether or not LVRR can be predicted by the baseline blood pressure or heart rate.

    Methods We conducted a single-center, retrospective observational study of newly diagnosed DCM patients from January 2017 to December 2020.

    Results Thirty-three newly diagnosed DCM patients were retrospectively examined. Spontaneous MA was observed during diagnostic cardiac catheterization in at least 1 of the pressure waveforms of the aorta, left ventricle, pulmonary artery, or right ventricle in 10 patients (30%) (MA-group). LVRR after OMT was achieved roughly equally in the MA group (6 of 10, 60%) and the non-MA group (12 of 23, 52%). In the MA group, those who achieved LVRR had a significantly higher baseline systolic aortic pressure (more than 120 mmHg in all 6 patients) than those who did not, although the baseline heart rate did not show a significant correlation with LVRR. In contrast, in the non-MA group, LVRR was unrelated to the baseline aortic pressure or heart rate.

    Conclusion The probability of LVRR in newly-diagnosed DCM patients with spontaneous MA was similar to that in those without spontaneous MA. Spontaneous MA may not necessarily be a sign of a poor prognosis if observed in patients with a preserved blood pressure.

  • Yosuke Nakagawa, Masao Toyoda, Nobumichi Saito, Noriko Kaneyama, Tomom ...
    2023 年 62 巻 12 号 p. 1715-1722
    発行日: 2023/06/15
    公開日: 2023/06/15
    [早期公開] 公開日: 2022/11/02
    ジャーナル オープンアクセス

    Objective Several studies have shown an increased risk of bullous pemphigoid (BP) when receiving dipeptidyl pepitidase-4 inhibitor (DPP-4i) treatment. The present study explored the associations of DPP-4i treatment with the clinical phenotypes and clinical course of BP.

    Methods We analyzed data of 146 patients with BP at Tokai University School of Medicine from December 1, 2009, to December 31, 2021. We obtained data by a retrospective medical record review and compared the bullous pemphigoid disease area index (BPDAI) between diabetes patients receiving DPP-4i treatment and those not receiving DPP-4i treatment. We employed multivariable linear regression models to explore the association between the DPP-4i treatment and the BPDAI scores.

    Results Among 53 BP patients with diabetes, 33 had developed BP during treatment with DPP-4i agents, among which vildagliptin was the most frequently used. The urticaria/erythema scores of the BPDAI were significantly lower in patients who developed BP while receiving DPP-4i treatment than among others. Of note, 69.2% of the patients who stopped DPP-4i treatment experienced complete remission, and the clinical course was more favorable in patients with lower scores for urticaria/erythema than among others.

    Conclusion These findings suggest that, in patients who developed BP while receiving DPP-4i treatment, a noninflammatory phenotype may indicate a high likelihood that DPP-4i treatment contributes to the development of BP. The discontinuation of DPP-4i should be carefully considered in close consultation with dermatologists.

  • Midori Sato, Erina Tabata, Tamiko Takemura, Ryo Okuda, Shigeru Komatsu ...
    2023 年 62 巻 12 号 p. 1723-1731
    発行日: 2023/06/15
    公開日: 2023/06/15
    [早期公開] 公開日: 2022/10/26
    ジャーナル オープンアクセス

    Objective Interstitial lung disease (ILD) is the most critical manifestation in patients with rheumatoid arthritis (RA). In some cases, ILD may appear before the RA onset. Some patients with an initial diagnosis of idiopathic interstitial pneumonia (IIPs) develop RA; however, few studies have reported on its features, and the details remain unknown. In the present study, the clinical, radiological, and pathological features were evaluated in patients with ILD preceding RA.

    Methods The clinical, radiological, and pathological features of patients with ILD preceding RA were retrospectively reviewed using the medical records.

    Patients Ten patients with ILD preceding RA out of 883 IIP patients who underwent a surgical lung biopsy at our hospital from 2004 to 2018 were retrospectively examined.

    Results The median patient age was 59 (range 50-76) years old, and 7 of the patients were women. The median time from the ILD diagnosis to the RA onset was 50 (range 33-65) months. Regarding the high-resolution computed tomography pattern, the "indeterminate for UIP" pattern was the most popular, and cysts were seen in all cases. Attenuation around the cyst was prominent. Pathological findings showed plasma cell infiltration, bronchus-associated lymphoid tissue (BALT), and bronchiolitis in the lobules. Cellular and destructive bronchiolitis was noticeable in many patients with ILD preceding RA and contributed to the destruction and dilation of the bronchiole.

    Conclusion In ILD patients with IIP, radiological and pathological findings with increased attenuation around the cysts, prominent inflammatory cell infiltration (especially in plasma cells), an increase in the BALT number, and cellular and destructive bronchiolitis might serve as helpful RA development indicators.

  • Takeshi Mochizuki, Koichiro Yano, Katsunori Ikari, Ken Okazaki
    2023 年 62 巻 12 号 p. 1733-1737
    発行日: 2023/06/15
    公開日: 2023/06/15
    [早期公開] 公開日: 2022/11/02
    ジャーナル オープンアクセス
    電子付録

    Objectives We investigated the factors associated with the deterioration of the Health Assessment Questionnaire-Disability Index (HAQ-DI) over five years in patients with rheumatoid arthritis (RA).

    Methods Clinical data were obtained from 391 patients who were classified into 2 groups: a group with HAQ-DI deterioration (in which the HAQ-DI had worsened) and a group without HAQ-DI deterioration. A multivariable logistic regression analyses of the age, sex, disease duration, body mass index, anti-cyclic citrullinated peptide antibody, the use of biological disease-modifying antirheumatic drugs or targeted synthetic disease-modifying antirheumatic drugs, methotrexate use, glucocorticoid use, C-reactive protein, pain visual analog scale (pain VAS), disease activity score 28 erythrocyte sedimentation rate (DAS28-ESR), the HAQ-DI, and van der Heijde modified total Sharp score was performed at baseline and five years to determine significant factors associated with the HAQ-DI.

    Results The significant factors associated with HAQ-DI deterioration were age [odds ratio (OR): 1.05; 95% confidence interval (CI): 1.02-1.08], glucocorticoid use (OR: 1.95; 95% CI: 1.03-3.71), DAS28-ESR (OR: 1.92; 95% CI: 1.33-2.79), change in pain VAS from baseline (OR: 1.02; 95% CI: 1.01-1.04), and change in DAS28-ESR from baseline (OR: 1.67; 95% CI: 1.15-2.44).

    Conclusion The present study suggests that glucocorticoid tapering as well as disease activity and pain control are required to prevent deterioration of the HAQ-DI in patients with RA.

  • Hideharu Hagiya, Mika Uno, Tsukasa Higashionna, Hiroyuki Honda, Fumio ...
    2023 年 62 巻 12 号 p. 1739-1742
    発行日: 2023/06/15
    公開日: 2023/06/15
    [早期公開] 公開日: 2022/10/26
    ジャーナル オープンアクセス
    電子付録

    Objective Amid the global spread of antimicrobial resistance, antimicrobial stewardship should be further promoted in the clinical setting. Our previous study suggested an intra-week disproportion of discontinuation of broad-spectrum antibiotics. We therefore explored the generalization of this prescription trend by investigating the use of all intravenous antibiotics.

    Methods A retrospective, observational study.

    Patients Between January 1, 2018, and December 31, 2020, we collected data on the initiation and discontinuation of intravenous antimicrobials on each day of the week and on days after holidays at Okayama University Hospital, Japan. We compared the monthly antimicrobial prescription initiation and discontinuation using the Kruskal-Wallis test and Mann-Whitney U-test with Bonferroni correction as a post-hoc procedure.

    Results Data from 15,293 hospitalized cases were analyzed. The initiation of antimicrobials differed slightly among days of the week, although this trend was clinically insignificant. Compared with the initiations, antimicrobial discontinuations were disproportionately biased among the weekdays, tending to occur on Mondays (p<0.001) about twice as often as on other days. Similarly, antimicrobials were unevenly discontinued on the day after holidays compared to other days (p<0.001), with an approximately 2-fold difference. The use of antimicrobials in the hospital was thus unequally terminated on weekdays.

    Conclusion To further promote antimicrobial stewardship, clinicians should be aware of the influence of behavioral, environmental, and social factors on antimicrobial prescription, which is seemingly beyond medical indications.

  • Kosuke Jo, Masahiro Kawashima, Junko Suzuki, Yoshiteru Morio, Hideaki ...
    2023 年 62 巻 12 号 p. 1743-1748
    発行日: 2023/06/15
    公開日: 2023/06/15
    [早期公開] 公開日: 2022/11/09
    ジャーナル オープンアクセス

    Objective The incidence of tuberculosis in Japan has been decreasing in the overall population but is increasing in older patients ≥90 years old. A poor performance status due to underlying diseases makes it difficult for patients with tuberculosis to receive standard oral treatment. However, there is no consensus concerning alternative treatments. This study examined the treatments and outcomes of older patients with tuberculosis and a poor performance status and determined the limitations of tuberculosis treatment for them.

    Methods We retrospectively enrolled 121 older patients with tuberculosis and a performance status of 3 or 4 due to underlying diseases during their hospitalization between April 2015 and March 2017 at National Hospital Organization Tokyo National Hospital. We classified them according to the drug administration route (oral, enteral, and injection routes) on admission and compared the characteristics and prognoses among the three groups.

    Results There were 79 patients in the oral route group, 28 (35.4%) of whom died during hospitalization. Among the 15 patients in the enteral route group, 6 (40.0%) died. Among the 27 patients in the injection route group who received non-oral agents, 22 (81.5%) died.

    The prognosis of the injection route group was poor, with a median survival time of 21 days.

    Conclusion Treatment success cannot be expected with injection treatment in patients with a poor general condition because of complications. Although injection treatment may be a viable alternative treatment, its establishment as the standard treatment cannot be currently endorsed.

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